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Corporate Compliance Clinical Auditor/RN

Corporate Compliance Clinical Auditor/RN

Category 
Nurse
Job ID 
2017-2963
Type 
Full Time 40
Location Name  
Corporate Office - Wilsonville
# of Openings 
1
Address 
25117 SW Parkway
Days of the week working 
M-F
City 
Wilsonville
Time of day and or shift schedule 
8-5
State 
Oregon
Territory the clinician will be covering (mileage radius/cities) 
..

More information about this job

Overview

Now Hiring!

 

Coporate Compliance Clinical Auditor/Registered Nurse

 

Signature Home Health and Hospice

  

Corporate Office - 25117 SW Parkway - Suite F - Wilsonville, Oregon 97070

 

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The Corporate Compliance Clinical Auditor is responsible for coordinating and conducting compliance clinical audit and internal control reviews in accordance with all State, Federal State and Medicare Regulatory guidelines and standards. These audits include data gathering, completing investigations, performing audits and analysis, communicating outcomes and creating effective ongoing monitoring and corrective training plans. The Corporate Compliance Clinical Auditor works under the direction of the Vice President of Clinical Operations and Compliance for Signature Companies. The position includes working with highly confidential material and acting as a liaison between all agencies and executive leadership team.

Responsibilities

  • Conducts and facilitates monthly, quarterly and annual agency clinical documentation audits for appropriate clinical documentation to ensure that overall quality, level of services and acuity of care are accurately reflected in a complete medical record, yielding the appropriate reimbursement for the level of services rendered and resources consumed.
  • Conducts and facilitates monthly, quarterly and annual agency clinical compliance audits for required forms, clinical orders and all policies and procedures are being followed required by Medicaid, Medicare and private insurance per State and Federal Regulations.
  • Conducts RAC, ADR, ZPIC and other payor audits. Responsible for working in collaboration with agency to prepare responses and appeals.
  • Responsible for collecting, analyzing and reporting of all findings to agency Clinical Managers, Administrator and executive leadership team.
  • Making recommendations to the agency Clinical Managers, Administrator and executive leadership team of improvement, correction and or training program where identified.
  • Developing relevant and individualized audit corrective action and educational plans of action. Works in conjunction with agency on coaching, training and in-services of clinical professionals at agency.
  • Works collaboratively with QA and Compliance Department and with agencies to not only improve documentation for quality reporting, but to report on trends associated with documentation to ensure compliance of regulations.
  • Develop specialized training and other material to enhance compliance with Commercial payors, Medicare and Medicaid statutes, regulations, attorney general opinions, bulletins and other guidance.
  • Establish effective means of company-wide communication and coordination of compliance issues and activities both directly and through the appropriate leadership. Present compliance issues at meetings with appropriate operations areas. Function as a resource for internal employees on compliance issues.
  • Review marketing materials for compliance with applicable regulations, accreditation standards, internal policies and contractual agreements and submit marketing materials for review and approval as appropriate.
  • Other duties as assigned by Vice President of Clinical Operations and Compliance.

Other skills needed:

  • Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.                           
  • Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions. 
  • Develop and use collaborative relationships to facilitate the accomplishment of work goals.                        
  • Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.              
  • Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.                          
  • Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
  • Effectively manage one's time and resources to ensure that work is completed efficiently.                
  • Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period.                
  • Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self-impose standards of excellence rather than having standards imposed.                        
  • Assimilate and apply new job-related information in a timely manner.                       
  • Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.  
  • Requires depth within a specialized, critical discipline and/or breadth of substantive professional knowledge that crosses disciplines within the professional field.
  • Interprets internal/external business challenges and recommends best practices to improve products, processes or services.                     
  • Leads others to solve complex problems; uses sophisticated analytical thought to exercise judgment and identify innovative solutions.               

Qualifications/Skillsets

  • Must possess a BSN degree from an accredited college or university. Prefer MBA or Higher education.
  • Must possess a current, unencumbered, active license to practice as an RN in this state.
  • Must have a minimum 3 years’ experience in Home Health and Hospice Clinical setting, prefer experience in primary and palliative care in addition.
  • Must have experience educating and presenting to clinical professionals.
  • Must have minimum of 2 or more years’ experience in clinical and or compliance auditing.
  • Experience with RAC, ADR, ZPIC and other payor audits, responses and appeals processes.
  • Project management skills, strong oral and written communication skills, analytical and reporting skills, and proficiency with MS Office products. HIPAA privacy and medical research experience is a plus.
  • Knowledge of CMS guidelines for post-acute care and services. Knowledge of home health, SNF/ALF and or rehab experience desired.
  • Knowledge of CMS Bundled Payment Care Initiative.
  • Knowledgeable in the fundamentals of case management, care coordination and/or care transition.
  • Knowledgeable of nursing and medical practices and procedures, as well as laws, regulations and guidelines that pertain to nursing care facilities.
  • Case management experience within health systems or insurance companies preferred.
  • Experience in discharge planning, home health, post-acute care preferred.
  • Experience working with Medicare, Medicaid and Managed Care Programs.
  • Experience with Electronic Medical Records and computer documentation systems.
  • Must be able to travel 50% or more per year to Oregon, Washington, Idaho, Wyoming and Utah.

Please apply on line for this position here:

 

https://careers-4signatureservice.icims.com

 

Samantha Bennett

Signature Services – Regional Recruiter
Tel: 503-607-0614 |C: 971-264-8367 | F: 1-866-415-6242

SBennett@4signatureservice.com |www.4signatureservice.com

Hospice | Home Health | Home Care

 

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